Provider Demographics
NPI:1467778175
Name:BENNETT, ROBERT STEVEN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:STEVEN
Last Name:BENNETT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 E SEVIER ST
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-3934
Mailing Address - Country:US
Mailing Address - Phone:501-315-4224
Mailing Address - Fax:501-778-0450
Practice Address - Street 1:307 E SEVIER ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-3934
Practice Address - Country:US
Practice Address - Phone:501-315-4224
Practice Address - Fax:501-778-0450
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAGSW#10506104100000X
AR2440-M104100000X
AR2593-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker